Transient cortical blindness following occipital lobe retraction in a pineal region meningioma resection.

Abstract

A woman in her 50s experiences complete cortical blindness following a successful resection of a pineal region meningioma, most likely secondary to intraoperative bilateral occipital lobe retraction. The post-operative MRI did not demonstrate any ischaemia. The index presentation was worsening recurrent falls and cognitive decline from a large mass in the pineal recess resulting in triventriculomegaly, managed successfully with an endoscopic third ventriculostomy 7 months prior. The enlarging mass was resected via a parieto-occipital interhemispheric approach with a 7 hour operative time and no complications. Immediately post-operatively, she experienced cortical blindness lasting 3 days, improving over 3 weeks to then normal visual function by 8 months. This raises awareness of intraoperative occipital lobe retraction increasing the risk of transient cortical blindness post-operatively, along with the known risk factors of increased age and tentorial angles. Future research with functional MRI is required to further investigate cases of post-operative cortical blindness.